Auditory verbal hallucinations (AVH) are experienced by approximately 70% of patients with schizophrenia. At the present time, there are no self-evaluation scales for auditory verbal hallucinations. They would allow the patient to self-assess their hallucinations when they occur, taking into account the great variability over time. Moreover, self-assessment allows the patients to better recognize their symptoms and to be more engaged in their treatment. In this context, we have developed a digital device (MIMO) allowing the patient to self-evaluate his/her AVH and to declare his/her hallucinatory crisis at any time. This device contains a self-assessment of auditory verbal hallucinations (SAVH) with 13 questions, 9 of which concern the frequency, the severity, the content and the impact of hallucinations. These 9 questions are rated on a 5-point scale ranging from 0 (absent) to 5 (severe). The patients and practitioners can have an online feedback on the scores as well as on their temporal changes.

The aim of this study was to validate the SAVH scale as well the digital tool, to demonstrate the acceptability by the patients and to prove the feasibility in using such a digital device (mobile phone or tablet).

Forty one patients with schizophrenia or schizoaffective disorder (DSM-5) with AVH loaded this application on their own mobile or on a loaned one. AVH was also assessed with the Auditory Hallucination Rating Scale associated with the Brief Psychiatric Rating Scale and the self-assessment of insight. Moreover, a questionnaire included a visual analogic scale on the global satisfaction of the device scoring from 0 (“Not at all satisfied”) to 10 (“Very satisfied”) and 22 questions concerning the conditions of use, the acceptability and the content of the app, its impact on mental health, and questions related to the declaration of hallucinatory crisis. Moreover, statistical analyses were carried out testing internal, external and construct validities of the SAVH.

56.1% and 36.6% of patients found the app to be easy and very easy to use, respectively. 61% and 29.3% of the patients considered that the questions were respectively rather adapted and very adapted to the evaluation of auditory hallucinations. 46.3% of patients found the questions quite easy to understand. The majority of patients felt that the MIMO app could be useful to them. Overall satisfaction was 8.073+-3.8 indicating very good overall patient satisfaction of the app. Statistical tests revealed significant convergence and divergence validities as well as good internal consistency of the SAVH.

This study demonstrated good psychometric properties of the SAVH and very good acceptability of this kind of assessment by digital device in patients with schizophrenia. Such a device can be quite useful to assess the efficacy of the treatment of AVH and to increase the patient’s empowerment.

None Declared

Early-onset schizophrenia (EOS) is a relatively uncommon disorder with psychotic symptoms emerging before 18 years of age. Although still under debate, EOS may be a more severe disorder relative to adult-onset schizophrenia (AOS), with worse prognosis. Cognitive deficits are a core feature of schizophrenia, accounting for a large part of the detrimental effect of the disorder and may reflect underlying neurodevelopmental disturbances. Some but not all previous studies show that the magnitude of cognitive deficits, including intelligence quotient (IQ), in patients with schizophrenia is dependent on the age of onset.

We aimed to assess IQ in adult patients with EOS and AOS, and healthy controls. We hypothesized that patients with EOS would show lower IQ than those with AOS, and both patient groups lower IQ than HC.

We included 136 adult patients with EOS (mean age: 24.7 (7.7) years, mean duration of illness: 9.3 (8.5) years, 50% women), 382 patients with AOS (mean age: 32.4 (9.5) years, mean duration of illness: 5.7 (6.6) years, 40.1% women) and 896 adult healthy controls (mean age: 33.2 (9.2) years, 47.1% women). We assessed current IQ with the Wechsler Abbreviated Scale of Intelligence (WASI) which yielded verbal (VIQ), performance (PIQ) and full-scale IQ (FIQ) scores. In a post-hoc analysis, we estimated premorbid IQ using the National Adult Reading Test (NART). We applied analyses of covariance (ANCOVAs) to investigate the putative differences in IQ scores and IQ change between patients with EOS, patients with AOS and healthy controls.

In sex-, and age-adjusted models, FIQ and PIQ, but not VIQ, were significantly lower in EOS than in AOS (p=0.03, p<0.001 and p=0.428, respectively) (Image). Patients with EOS had fewer years of education than patients with AOS (p<0.001); the PIQ but not the FIQ difference between EOS and AOS remained significant after adjustment for education years (p=0.016 and p=0.333, respectively). Both patient groups had significantly lower IQ scores than healthy controls (Image). Further, patients with EOS and patients with AOS did not significantly differ in estimated premorbid IQ (109 and 110 units, respectively, p=0.092), whereas patients with EOS had a significantly larger estimated IQ decline after the disease onset compared to patients with AOS (12 and 9 units decline, respectively, p=0.015).

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Our findings show that adult patients with EOS have significantly lower PIQ and FIQ scores, and significantly larger IQ decline after the disease onset, but not lower premorbid IQ, compared to patients with AOS. The adolescent onset of psychotic symptoms is linked, as expected, to fewer total years of education, which appears to explain the lower FIQ but only partially the lower PIQ in EOS, which may thereby be linked to the disorder per se.

T. Calkova: None Declared, L. Mørch-Johnsen: None Declared, R. Elle Smelror: None Declared, K. Nordbø Jørgensen: None Declared, S. Cervenka: None Declared, K. Collste: None Declared, A. Vaskinn: None Declared, A. Margrethe Myhre: None Declared, O. A. Andreassen Consultant of: HealthLytix, Speakers bureau of: Lundbeck and Sunovion, T. Ueland: None Declared, I. Agartz: None Declared, D. Andreou: None Declared

Due to the exacerbation of psychotic processes in acute psychiatric services, patients may exhibit risky behaviors for themselves and others. Especially, psycho-motor agitation seen in schizophrenia may result in some harmful behaviors towards him/her self or other individuals in patient. Physical restrain, or chemical restrain with psychotropic drugs can be used for ensuring the safety of the patient with a tendency toward violent behavior and to prevent harm to himself and others. These restrain methods are usually applied when they showed aggressive or violent behaviors, that is after the observed warning signs or real violent behaviors.There is no system that can evaluate and notice agitation or tendency of violence before the obvious behaviors. By using a wearable sensor system to be able to measure some biological change and to evaluate of the sensors’ ability to obtain quantitative and objective data may help the health professionals to prevent the damage in advance.

The aim of this pilot study was to evaluate the changes in measurements of the four wearable sensors which applied to persons with schizophrenia.

Ten patients who restrained in the observation room, selected for this pilot study. On the first day (13:00), which meets the criteria for inclusion in the study and the end of the insulation process (the COVID test result is negative), the first measurement was before the noon treatment. The patients’ second measurements were taken on the day they switched from parenteral to oral treatment. For measurement, the sensor circuits developed at the Physiological Analysis and Wearable Systems Research Laboratory of Koç University were connected to various parts of the body to collect the non-invasive data detailed below. In addition, including the clinical status of the patient in the experimentation process, and a positive-negative syndrome scale was also used. The data from the patient was obtained under the supervision of the clinical chief nurse for 10 minutes. Sensors were electrocardiogram (ECG) photoplethysmogram (PPG), seismocardiography (SCG), body temperature.

Since some recording errors observed in two patients’ records, the data of eight patients were evaluated. Aside from one of the eight patients evaluated, the signal deviation and strength of other patients’ data increased in general. This result imply that signal deviations and strengths may be reduced during the psychomotor agitation. These deviations may suggest that this sensor system is capable to evaluate some biological changes in patients.

Considering the results of the pilot study, it is planned to carry out future studies with a larger sample size and longer records. With these studies, it is thought that psychomotor agitation in patients can be determined in an objective and measurable way without risk.

None Declared

In schizophrenia, there is evidence for anomalies in the extension and plasticity of the peripersonal space (PPS), the portion of space surrounding our body, plastically shaped through motor experiences. An impaired multisensory integration at the PPS level would underpin the disembodiment, a core feature of the disorder linked to subjective perturbations of the sense of self (“Self-disorders”) and of the intersubjective dimension (“schizophrenic autism”).

The present study was aimed at: 1) exploring possible associations between PPS data, psychopathological dimensions, and subjective experiences in schizophrenia; 2) identifying a specific PPS profile in patients with early-onset schizophrenia.

A motor training with a tool was used to assess the PPS size and boundaries demarcation in twenty-seven schizophrenia outpatients. Moreover, they underwent a thorough psychopathological evaluation with the Positive And Negative Syndrome Scale (PANSS), the Examination of Anomalous Self Experience scale (EASE) and the Autism Rating Scale (ARS). Subsequently, the sample was divided into early (EOS) and adult-onset (AOS) subgroups, that were compared with respect to their PPS and psychopathological profiles.

PPS features (size and boundaries demarcation) were associated with PANSS negative score, subjective experiences of existential reorientation (EASE Domain 5 scores) and traits of schizophrenic autism (ARS scores; Fig. 1). PPS parameters (Fig. 2) and ARS scores, but not PANSS and EASE differentiated between early and adult-onset subgroups.

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Our results suggest a link between PPS patterns, negative symptoms, and disturbances of the subjective experience, particularly in the intersubjective domain, in schizophrenia. Moreover, they candidate specific PPS profiles and schizophrenic autism traits as EOS markers.

None Declared

Patients with schizophrenia present severe communication difficulties in various linguistic areas. In the last two decades research has invested significant effort in trying to better characterize the linguistic profile of patients with schizophrenia, with the purpose to help and guide diagnosis and treatment. Moreover, speech data could be easily gathered through non-invasive techniques and are therefore seen as particularly promising by clinicians. However, surprisingly very little is known about interactional dialogue management, i.e. turn-taking, in these patients. ‘Schizophrenic autism’, the peculiar intersubjective experience also linked to anomalies in the sense of the self (‘Self-disorders’) presented by these patients, could be at the basis of an unusual turn-taking management.

The objective of the present study was to investigate turn-taking patterns of patients with schizophrenia and to explore their possible associations with psychopathological dimensions and subjective experiences.

We obtained double-channel audio-recordings from interviews with twenty patients with schizophrenia (SCZ) and twenty healthy controls (HC). Participants answered general questions to elicit spontaneous dialogues, to improve the ecological validity of the task. The audio files obtained were then analyzed with Praat, a software widely used in experimental phonetics. We subsequently quantified a set of conversational metrics (participant floor occupation, mutual silence, overlap between speakers, speaking turn and pause duration). Patients also underwent a thorough psychopathological and phenomenological evaluation with the Positive And Negative Syndrome Scale (PANSS), the Examination of Anomalous Self Experience scale (EASE) and the Autism Rating Scale (ARS).

Our results show that the SCZ group displayed a reduced participant floor occupation, an increased mutual silence, and shorter speaking turns as compared to the HC. (Fig. 1, Fig. 2). We found significant associations between conversational features and psychopathology (Fig. 3). Two multivariate linear regressions showed that the participant occupation floor and the average speaking turn duration (dependent variables) were negatively related to the severity of negative symptoms and Self-Disorders. Interestingly, Self-Disorders were the best predictors of conversational engagement.

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Our results, although preliminary, suggest the existence of peculiar turn-taking patterns in schizophrenia, linked to negative symptoms and disturbances of the subjective experience, particularly in the Self domain. Our results suggest also how the use of experimental linguistic methodology is applicable to clinical settings and underscores the importance of research projects in this field that are strongly interdisciplinary in both design and conduct.

None Declared

Schizophrenia is a large and increasing burden for patients from early stages of the disease. Long-acting injectable antipsychotics (LAIs), like aripiprazole once-monthly 400 mg (AOM400), have demonstrated an improvement in treatment adherence compared to oral formulations, with a consequent reduction in time to remission and risk of relapse.

This study aims to compare the hospitalisation rate in individuals with schizophrenia who started their treatment with AOM400 or atypical oral antipsychotics (OA) in a real-world setting in Spain.

This is an observational and retrospective study based on the electronic medical records of the BIG-PAC database. Adults diagnosed with schizophrenia who initiated treatment with AOM400 or atypical OA (olanzapine, risperidone, paliperidone, aripiprazole or asenapine) from 01/01/2017 to 31/12/2019 were included. A 1:1 propensity score matching (PSM) was conducted to match individuals from both cohorts. Healthcare resource use and treatment persistence (with AOM400 or OA) were also analysed after 12 months.

After the PSM, 1,017 individuals with similar baseline characteristics were included in each cohort (total population: 2,024 individuals). At index date (treatment initiation) patients were 41.4 years (standard deviation, SD: 10.6), 54.6% were male and had received 1.6 (SD: 0.9) previous antipsychotic treatments. During the follow-up period, the AOM400 cohort had a 40% lower risk of hospitalisation than the OA cohort (hazard ratio, HR: 0.60 [95% confidence interval, CI: 0.49 – 0.74]). The median time to the first hospitalisation was longer in individuals with AOM400 compared to those with OA (197 compared to 174 days; p<0.004), whereas median length of hospital stay were shorter (6 and 11 days for AOM400 and OA, respectively; p<0.001). The AOM400 cohort also required fewer visits to primary care, specialized care and emergency rooms than the OA cohort (p≤0.005). After 12 months, the AOM cohort was more persistent than the OA cohort (64.9% compared to 53.7%; p<0.001).

AOM400 reduces the number and duration of hospitalisations and improves treatment persistence compared to atypical OA. Our results suggest that the use of AOM400 may reduce the burden of schizophrenia in Spain.

None Declared

Previous studies have shown an association between high Body Mass Index (BMI) and worse cognitive performance in obese patients and the general population. Cognitive deficits and overweight are important challenges in the clinical treatment of psychosis but scarcity of studies have investigated this relationship. Moreover the effect of sex in the psychosis research has been neglected since recent years and there is still a lack of studies taking into account the sex differences

To determine the effect of overweight and its interaction with sex on cognitive performance in First Psychotic Episodes (FEP)

We included 159 FEP out-patients (mean age 23.1 years 33.3% females ) in their first year of antipsychotic treatment attending to the Early Intervention Program of the Institut Pere Mata, in Reus. At study entry participants underwent to a comprehensive clinical, biometric and cognitive assessment by standardized neurocognitive battery (MATRICS Consensus Cognitive Battery; MCCB). T scores were converted to standard equivalents (z-scores) based on data from a healthy control group from the same geographical area.

Overweight was defined as BMI≥ 25 according to WHO standards. Two-way ANCOVAS were performed to determine the interaction effect between overweight and sex on the cognitive tests. Ethical approval was obtained by the Committee for Ethical Clinical and Pharmacological Investigation of the Pere Virgili Research Institute

At study entry 85% of participants were on antipsychotics for less than 6 months with a median dose of 300 (200-450) chlorpromazine equivalents (CPMZ) in mg/day. 37.7 % of participants were overweight without differences between men (41.5%) and women (30.2%) (X2 = 1.47; p = 0.22). There were no clinical and treatment differences between overweight and normal weight participants. With regards sex differences, females presented statistically significant higher scores in Calgary depression scale and lower doses of antipsychotics. No differences were found in cognitive performance regarding weight status but we found a significant interaction between sex and overweight in verbal learning memory ( F=6.09; p=0.01). When controlled for depressive symptoms and CPZM equivalents differences continued to be significant. Overweight females performed worse -1.09 ( SD 1.18) than normal weight females -0.23 (SD 1.10); (t= 2.57;p=0.02) in verbal learning memory whereas that difference was not found among overweight and normal weight males (t= -1.10; p=0.27)

Our results provide evidence for sex-differences on cognitive function depending on weight status. Advances in the study of sex differences in FEP would help to target specific treatment strategies

None Declared

A large body of evidence shows that both genetic and environmental factors play an important role in the etiology of schizophrenia. There is also growing evidence of an interaction between these factors.

To investigate the influence of family history of schizophrenia, which reflects the contribution of genetic factors, and birth in the winter months, considered as an important environmental risk factor for this disease, on the clinical characteristics of schizophrenia.

The results of a clinical examination of 1590 inpatients with schizophrenia (F20.0 ICD-10) were analyzed. The analysis included clinical characteristics of the disease (age of onset of the disease, severity of symptoms, which were assessed by PANSS), information about the family history of schizophrenia, and the season of birth (SOB) of the patient. Data analysis was carried out using multivariate analysis of variance, in which clinical characteristics were used as a dependent variable, and the presence/absence of schizophrenia in first-degree relatives of the patient, patient’s birth in the winter months/birth in other months of the year, sex were independent factors.

The study group included 1153 women and 437 men. Family history was present in 569 patients (427 women) and absent in 1021 (726 women). In 415 (26.1%) cases, patients born in the winter months. In the group without family history, the percentage of births in the winter months did not differ from that in the group with family history. There was an effect of sex on the age of onset of the disease as well as on the severity of positive symptoms, which were higher in women (p =0.0000). Family history of schizophrenia had a significant, sex-independent effect on the age of onset. The disease manifested at an earlier age in patients with family history. Being born in the winter months was not associated with either age of onset or positive symptoms. There were significant main effects of family history (p=0.018) and birth in the winter months (p=0.044) on negative and general psychopathological symptoms, which were not mediated by sex. The additive effect of these factors was found at the trend level (p=0.08), while the greatest severity of negative symptoms was observed in the group with a family history and birth in the winter months (p=0.02). A significant additive effect (p=0.012) of family history and birth in the winter months on general psychopathological symptoms was found. As in the case of negative symptoms, the greatest severity was noted in the presence of both factors.

Family history and birth in the winter months are not only risk factors for the development of schizophrenia, but also affect the severity of the disease. The results indicate the feasibility of further molecular genetic studies on this sample, both using candidate gene analysis and genome-wide analysis with polygenic risk assessment.

None Declared

The negative consequences of the stigmatization of mental illness significantly impair health care system, society, patients and their families. It has been established, that more than 40% of patients with schizophrenia suffer from self-stigmatization (E. Brohan et al., 2010), what determines the relevance of research aimed at it’s reduction.

To assess the level, components of self-stigmatization and associated with it factors in patients with schizophrenia, receiving psychosocial treatment in the community; to propose and implement a complex of interventions for destigmatization.

The battery of instruments was used: Self-stigmatization questionnaire (V.S. Yastrebov, I.I. Mikhailova et al., 2005), revealing the patient’s tendency to explain their problems in the main areas of psychosocial functioning as manifestations of the disease or the prejudice against them; Emotional intelligence questionnaire (D.V. Lyusin, 2006); Quality of life questionnaire (J.E. Ware et al., 1995); Montreal Cognitive Assessment (Z.S. Nasreddine, 1996). 40 patients with schizophrenia (ICD-10 F.20), receiving psychosocial treatment in a non-profit organization in community, were examined.

The overall level of self-stigmatization in the studied patients constituted 42.8% or an average level of self-stigmatization. Using Self-stigmatization questionnaire, nine components of self-stigmatization were revealed. The most pronounced indicators were in following components: “Reassessment of self-realization”, “Readiness to distance from the mentally ill in the social sphere”, “Reassessment of internal activity” (56.2%, 56.5%, 55.1% correspondingly). By the forms of self-stigmatization demonstrated that patients with autopsychic form (the justification of their failure by the disease) constituted the largest proportion or 41%. The compensatory form (denial of one’s incompetence with its exaggeration in other mentally ill people) and socio-reversive form (explaining incompetence by the prejudice against them) had similar rates in 29% and 30% of patients, correspondingly. Inverse strong correlations with some of scales of the Emotional intelligence questionnaire, Cognitive scale and the Quality of life questionnaire were established. Destigmatization training for patients with schizophrenia based on cognitive behavioral psychotherapy was worked out. A set of destigmatization interventions was proposed and implemented.

A complex of different interventions taking into account the form of self-stigmatization and it’s main components, should be used. These interventions have to include psychoeducation, cognitive trainings, self-esteem trainings and special destigmatization trainings.

Keywords: schizophrenia, self-stigmatization, destigmatization trainings

None Declared

Studies show that patients diagnosed with residual schizophrenia are characterized by cognitive and emotional-volitional disorders that increase with age. They can be the main barrier to treatment, psychosocial rehabilitation, and cause disability.

To identify cognitive and emotional-volitional disorders in patients with residual schizophrenia.

The BACS and the abbreviated MMPI test were used; 20 patients with residual schizophrenia (ICD-10 F.20.5xx) receiving outpatient treatment (mean age 59.65±14.24 years) were examined. Exclusion criterion: scores more 4 on at least one parameter of positive symptoms according to the PANSS.

Patients with residual schizophrenia show an overall decline in cognitive function (BACS composite score = 31.56±14.24) compared with healthy individuals, as well as compared with patients suffering from other forms of schizophrenia spectrum disorders. The greatest deficiency was revealed in the speed of information processing (subtests “Symbol Coding”=28.01±10.06; “Verbal Fluency”=37.56±11.57) and auditory-speech memory (subtest “Verbal Memory”=33.25±6 .02). These parameters showed significant associations (r=0.56 at p≤0.01) with the disability of such patients. However, this deficit could be compensated by the relative preservation of planning processes and executive functioning (subtest “Tower of London” = 14.91±4.57). Among the emotional and volitional disorders, the most important is the subjective feeling of low mood and paranoid tendencies (MMPI scales “Dp” = 56.38±10.74T, “Pa” = 59.06±14.49T), which can reduce the compliance of patients with residual schizophrenia.

Methods for leveling cognitive and emotional-volitional disorders should to include in programs of psychosocial rehabilitation of patients with residual schizophrenia.

None Declared

Research suggested that psychosis and mental illness-related experiences can be extremely traumatic, and that psychosis could theoretically also lead to posttraumatic growth (Mazor et al., 2019; PTG). The promotion of PTG may contribute to the treatment of people who experienced massive traumas such as people with severe mental illness (SMI). Psychotic symptoms are a common feature of SMI, and individuals who have experienced psychosis are also more likely to have been exposed to trauma and are more vulnerable to developing posttraumatic symptomatology (Ng et al., 2021). Negative symptoms such as amotivation could also contribute to the traumatic experiencing of psychosis (Mazor et al., 2016). Amotivation is specifically relevant to the possible traumatic sequelae of psychosis (Mueser et al., 2010). Alongside the adverse consequences of psychopathological symptoms is the unique outcome of coping with adversity (Tedeschi & Calhoun, 1995)- PTG. Two important factors that contribute to PTG is coping self-efficacy (CSE), and meaning making (Mazor et al., 2018). We investigated the possibility of PTG in individuals with SMI, through the mediating effect of CSE and meaning making.

Recent research has shown high rates of exposure to trauma among people with SMI, and that psychosis and mental illness-related experiences can be extremely traumatic. While some develop PTSD, it has been noted that some may also experience PTG. However, few studies have examined PTG in this population.

121 participants were recruited from community mental health centers and administered trauma and psychiatric questionnaires. Study protocol was approved by the University of Haifa ethics board.

High levels of traumatic exposure were found in the sample. Furthermore, we found that people who endured psychosis can experience PTG, which was mediated by meaning making (MLQ) and CSE. Psychotic symptoms were found to be a major obstacle for PTG, whereas negative symptoms were found to have the potential to lead to PTG when mediated by meaning making and CSE.

Mediation analyses for the dimensions of PANSS, MLQ total, CSE total, and PTGI total (N=121)

The portrayed research provided preliminary evidence for the potential role of meaning making and CSE as mediators of PTG in the clinical, highly traumatized population of people with SMI who have experienced psychosis.

None Declared

Cognitive impairments, the main determinants of functional outcomes in schizophrenia, had limited treatment responses and need a better understanding of the mechanisms. Dysfunctions of the dopamine system and N-methyl-D-aspartate receptor (NMDAR), the primary pathophysiologies of schizophrenia, may impair cognition.

This study explored the effects and interactions of striatal dopamine transporter (DAT) and plasma NMDAR-related amino acids on cognitive impairments in schizophrenia.

We recruited 36 schizophrenia patients and 36 age- and sex-matched healthy controls (HC). All participants underwent cognitive assessments of attention, memory, and executive function. Single-photon emission computed tomography with 99mTc-TRODAT and ultra-performance liquid chromatography were applied to determine DAT availability and plasma concentrations of eight amino acids, respectively.

Compared with HC, schizophrenia patients had lower cognitive performance, higher methionine concentrations, decreased concentrations of glutamic acid, cysteine, aspartic acid, arginine, the ratio of glutamic acid to gamma-aminobutyric acid (Glu/GABA), and DAT availability in the left caudate nucleus (CN) and putamen. Regarding memory scores, Glu/GABA and the DAT availability in left CN and putamen exhibited positive relationships, while methionine concentrations showed negative associations in all participants. The DAT availability in left CN mediated the methionine-memory relationship. An exploratory backward stepwise regression analysis for the four biological markers associated with memory indicated that DAT availability in left CN and Glu/GABA remained in the final model.

This study demonstrated the interactions of striatal DAT and NMDAR-related amino acids on cognitive impairments in schizophrenia. Future studies to comprehensively evaluate their complex interactions and treatment implications are warranted.

None Declared

The peculiar requests of postgraduate teaching could affect the students’ lives, predisposing them to mental disorders and suicide risk (e.g. Abreu et al., 2021). The Interpersonal Psychological Theory of Suicide (IPTS) (Joiner, 2005) is a model that has proved useful in explaining this risk.

We analyzed risk factors associated with current suicidal ideation (SI) and history of suicidal planning and/or suicide attempt (SP/SA) in a sample of 97 Italian residents in psychological (n= 17, 17.5%) and medical and health care area (n=80, 82.5%) (mean age 29.18±3.25 SD).

Socio-demographic, psychological (i.e. State-Trait Anxiety Inventory, Beck Depression Inventory – II; BDI-II, Rosenberg Self-Esteem Scale, Reasons For Living Inventory; RFL, Psychache Scale, Mental pain questionnaire; MPQ, Visual Analogue Scale - VAS - on mental pain, Acquired Capability for Suicide Scale-Fearlessness About Death) psychosocial (i.e. Interpersonal Needs Questionnaire; INQ, UCLA Loneliness Scale Version 3, Multidimensional Scale of Perceived Social Support; MSPSS) and somatic pain features (i.e. VAS, Pain Vigilance and Awareness Questionnaire; Self-Awareness Questionnaire; SAQ) were collected through an online questionnaire. We compared residents with SI vs No SI and residents with SP/SA vs No SP/SA and the emerged significant variables, have been inserted in logistic regression models with stepwise method, backward elimination.

The presence of depression (BDI-II), low reasons for living (RFL), psychological pain (Psychache Scale and MPQ), interoceptive awareness (SAQ), Thwarted Belongingness (TB, INQ subscale), loneliness (UCLA) and low perceived social support (MSPSS) were associated with both current SI and history of SP/SA. Concerning regression models, TB (INQ) increased the likelihood of SI while Survival and Coping Beliefs (RFL subscale) reduced it. The model explained 49% of the variance of SI by correctly predicting 88.7% of SI cases. Perceived social support (MSPSS)reduced the likelihood of current SP/SA levels while interoceptive awareness (SAQ) increased it. This model explained 40% of the variance of SP/SA by correctly predicting 82.5% of suicide risk cases.

We have identified risk and protective factors for suicide, consistent with the IPTS, which can orient the prevention, evaluation and clinical treatment of residents.

None Declared

Suicide, was defined as the act of intentionally taking one’s own life, understanding the lethal consequences of the act committed. The global suicide rate is 10.5 cases per 100,000 inhabitants, being lower in America, where it reaches values of 7.3 deaths per 100,000 inhabitants.

The Embera ethnic group is a Latin American indigenous people, of Chocó ethnolinguistic origin, which is located in the countries of Panama, Colombia and Ecuador; Particularly within the Embera ethnic group, a phenomenon of suicide in waves has been documented in journalistic media, which has been called “The Epidemic of the ropes”.

The data was collected in 2020, within the Río Salaquí-Isletas indigenous reservation (Riosucio-Chocó), in which multiple cases of suicide have occurred in the new millennium, without knowledge of previous cases.

To calculate the suicide rate and its trend over time in the Río Salaquí indigenous reservation, among 1999 and 2019 and compare the suicide rate and its trend with official data from Colombia, determining differences between the two.

A descriptive study with an analytical component will be carried out. The data was collected in 2020, within the Río Salaquí-Isletas indigenous reservation (Riosucio-Chocó-Colombia). The information was taked from no structurated interviews conducted with individuals from the community.

The validation of the cases and the selection of duplicate cases was carried out through checklists created by the researchers. When calculating the specific suicide rates, the estimated population in the community is obtained from official censuses and local authorities.

Statistical analysis to determine whether the suicide rate; It was carried out with the SPSS program, using a confidence interval on the rate, which would allow estimating its variability with 95% reliability.

Data of deaths by suicide were collected in people of any age, residents of the Río Salaquí Indigenous Reservation (Isletas), between the decade of 1999 and 2019, as well as the total population of the community for the calculation of suicide rates. suicide.

Among the 10 years evaluated, 22 deaths by suicide were found, of which 13 (59%) corresponded to men and 9 (41%) to women. The suicide rate in Río Salaquí for this decade was 88.8 cases per 100,000 inhabitants 95% CI (68.7-375.8), with peaks in some three-year periods analyzed and no deaths by suicide before 2001. On the other hand, the The national suicide rate in Colombia for this decade was 4.56 cases per 100,000 inhabitants 95% CI (4.18-4.87).

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During the development of the study is evident that in the indigenous reservation in the Salaqui river the suicide rate is significantly higher than in the national rates, it is even higher than the worldwide rate of suicide since the year 2001.

None Declared

Suicide is recognized as a social problem and the interest in preventive measures to diminish suicide risk is constantly increasing. But scientific research results that distinguish between those who have only suicidal ideation (SI) and those who have a history of Suicidal attempts (SA) are limited. Inhibitory control is regarded as an important ability related to the transition from suicidal ideation to suicide attempts. In event-related potential, patients with dysfunction of inhibitory control demonstrate a reduction in the no-go amplitude.

This study aimed to determine the association between the no-go event-related potential component and suicidal behaviors among suicide attempters and ideators who never attempted suicide.

Overall, 150 patients who visited the emergency room by suicide attempts or patients who visited the psychiatric department with suicidal ideation were recruited and instructed to perform a go/no-go task during electroencephalography recording. The Beck Depression Inventory, Beck Anxiety Inventory, Barratt Impulsivity Scale, Difficulties in Emotional Regulation Scale, and Acquired Capability for Suicide Scale were used. Individuals were divided into two groups: those with suicidal attempts (SA group) and with suicidal ideation (SI group) without SA. The psychological characteristics and event-related potentials of the two groups were compared. Correlation analyses were conducted to test the association between the clinical characteristics and event-related potentials.

The SA group had significantly decreased no-go P3 amplitudes at all electrodes compared to the SI group. In the correlation analysis between the clinical measurements and event-related potentials in all the participants, no-go P3 amplitudes in whole electrode sites were negatively correlated with the scores of the acquired capability for the suicide scale.

This study revealed that suicide attempters have dysfunction in controlling inhibition compared to suicide ideators reflected in the no-go P3. Our findings suggested that no-go P3 can be a biomarker associated suicide attempts in suicide ideators.

None Declared

It is known that the restrictions and clinical changes experienced during the pandemic period have negative effects on the care and treatment of psychiatric patients. However, insights on how the pandemic environment and the approaches of healthcare professionals serving during the pandemic affect the care and treatment of patients at risk of suicide are insufficient.

This ethnographic study aimed to identify the approaches of psychiatric nurses in managing suicide risk during the pandemic period in relation with their work environment.

This ethnographic research design used a sample of 13 psychiatric nurses in a psychiatric clinic in Ankara. Data were collected with in-depth interviews, participant observations and observant participations. Data were obtained from a total of 612 hours of observation and 13 planned nurse interviews. Data were analyzed using qualitative thematic analysis.

The emergent main theme from data analysis is explained under the title of “The risk of loss of inauthenticity in suicide risk management”. “Risk of loss of inauthenticity” means the fact that the individual suicidal risk factors and differences of the patients cannot be perceived/assessed by the nurses.

Supposing all patients having the same suicide risk level by psychiatric nurses caused insensitivity to risky patients in the care process. Nurses’ inadequate approach to patient personality disorder and limited social interactions due to the pandemic atmosphere made it difficult for nurses to have knowledge and understanding of how patients cope with suicidal ideations. These findings show the importance of the use of valid and reliable scales with risk formulations and the significance of triage in crisis periods such as current pandemic. In addition, creating available online consultancy service alternatives may have an important role in the management of suicide risk for patients who are disturbed by long-term hospitalization. Also these findings may contribute to the creation of qualified care and treatment guidelines on suicide risk management for crisis periods.

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Though the literature suggests a strong association between depressive symptoms and suicidal ideation, in clinical practice, it is often observed that many patients who show those symptoms, even the most severe, do not experience suicidal ideation. Thus, the association between depressive symptoms and suicidal ideation is insufficient to explain the complexity behind suicide. From Shneidman’s point of view, the common feature in patients with suicidal ideation and suicidal behavior seems to be mental pain, defined by the author as “psychache” and characterized by a distressed state of mind, in which the subject experiences extreme angst, hopelessness and in which pain is seen as unsolvable. Individuals with depressive symptoms are suicidal only when psychache is so unbearable that suicide is perceived as the only option.

Our study aimed to investigate the association among depressive symptoms, mental pain, and recent suicidal ideation, specifically whether mental pain could mediate the relationship between depressive symptoms and current suicidal ideation in a sample of psychiatric patients.

Participants were 206 adult patients (49.5% females). Patients were assessed for psychiatric diagnoses according to DSM-5. For the study, the following instruments were administered: the Columbia-Suicide Severity Rating Scale (C-SSRS), the Beck Depression Inventory-2 (BDI-2), and the Orbach & Mikulincer Mental Pain Questionnaire (OMMP).

32.5% of the patients had bipolar disorder, 21.4% had MDD, 24.8% had schizophrenia or other psychotic disorders, and 15% had a personality disorder. About 34% of the patients reported recent suicidal ideation with at least some intent to act. Recent suicidal ideation was associated with both mental pain and depressive symptoms, but mental pain completely mediated the association between depression and suicidal ideation (β=.04, SE=.01, 95% CI (.01/.06).

Our study indicated that patients with more severe depressive symptoms are more likely to report suicidal ideation and that the presence of mental pain could explain this association thoroughly. Thus, in clinical practice, the identification of mental pain confirms its crucial role in the assessment of suicide risk and in the understanding of the individual’s unique pain.

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The Crisis Response Team (CRT) is an interprofessional collaboration between the Singapore Police Force (SPF) and the Mental Health Helpline (MHH) of the Institute of Mental Health (IMH). Supported by a multidisciplinary team comprising of the SPF, IMH psychiatrists, community psychiatric nurses and crisis counsellors, and community partners, this intervention aims to support suicidal individuals, depending on their risk severity, residing in the community.

To present the CRT work process and to explore the characteristics and outcomes of suicide-related cases referred.

In this descriptive research study, a quantitative approach is adopted. An Excel file shared across the helpline counsellors is used to collate information of the referred cases. Data collected from October 2021 to August 2022 were evaluated using the IBM SPSS Statistics for Windows v28.0. Descriptive statistics were used to summarise the characteristics and outcomes of the cases.

Figure 1 shows the CRT work process. To standardise the method of assessing both suicide ideation and behaviour, the Columbia-Suicide Severity Rating Scale (C-SSRS) is utilised. As compared to other suicide ideation and behaviour scales, the C-SSRS has demonstrated good convergent and divergent validity, high sensitivity and specificity for suicidal classifications, and moderate to strong internal consistency (Cronbach’s α: 0.73 - 0.95) (Posner et al. AJP 2011; 168(12) 1266-1277). A total of 3,386 suicide-related cases was referred. The age range of the suicide-related cases range from 8 – 97 years old (M = 36, SD = 17.33). Of these 3,386 cases, 627 cases were discharged back to their family members/employer/friend/partner and with follow-up check-in calls by the MHH counsellors, 416 cases were sent to the restructured hospitals for organic workup, 2,268 cases were brought back to IMH, 55 cases were discharged back to the SPF for further investigation, and 20 cases warranted CRT home visit activations. Figure 2 shows the total number of referred cases and outcome of these cases in each month.

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The CRT intervention could mitigate suicide risk and pressure on the mental health system (i.e., reduce unnecessary emergency room visits and hospital admissions), create greater mental health awareness, and facilitate individuals’ connection to mental healthcare services (i.e., in hospitals and/or in the community) as evidenced by the increasing number of cases referred, and increased collaboration with the various stakeholders, ensuring timely intervention and necessary follow-ups thereafter.

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There is growing evidence on the existence and the clinical usefulness of the recently described Suicide-Specific Syndromes (SSS), such as the Acute Suicidal Affective Disturbance (ASAD) and the Suicidal Crisis Syndrome (SCS). Many researchers and clinicians agree that Suicide-Specific Syndromes, as a distinct diagnostic category should be included in the major diagnostic and classification systems, such as the Diagnostic and Statistical Manual of Mental Disorder (DSM) or the International Classification of Diseases (ICD). In addition to their novelty in symptomatic and nosologic classification, the recently developed Acute Suicidal Affective Disturbance Inventory (ASADI) and the Suicidal Crisis Inventory (SCI) also provide an opportunity to objectively measure the current suicidal emotional and mental state by validated tools.

To assess the clinical usefulness of the ASADI and the SCI compared to each other and to traditional suicide risk assessment tools based on classical suicide risk factors.

A self-administered questionnaire battery and a semi-structured interview were completed with 100 psychiatric inpatients consecutively treated with depressive disorders and/or suicidal behaviour in a university clinic in 2021. Besides the ASADI and the SCI, the self-administered battery included depression screening tools, such as the Beck Depression Inventory - Short Form (BDI-SF) and the Patient Health Questionnaire - 9 items (PHQ-9). Traditional suicide risk factors were assessed by clinical judgement and with the Brief Suicide Questionnaire (BSQ).

According to our preliminary results, the ASADI and the SCI recognize Suicide-Specific Syndromes as distinct diagnostic entities. Furthermore, ASADI and SCI detect suicidal behaviour as effectively as traditional suicide risk assessment tools, and may be more effective in assessing imminent suicide risk. There were no significant differences in detecting suicidal behaviour and in assessing suicide risk between the ASADI and the SCI.

Suicide-Specific Syndromes (ASAD, SCS) use well-defined diagnostic criteria for suicidal behaviour. The recently developed different tools for assessing Suicide-Specific Syndromes, such as the ASADI and the SCI may be helpful tools for the clinicians to assess suicidal behaviour and imminent suicide risk in their clinical practice.

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Changes in physiological and hormonal balance occurring during pregnancy and post-partum period can have relevant implications on woman’s mental health. Up to 65% of pregnant women experience depressed mood, low self-esteem, cognitive impairment, fatigue, loss of appetite as well as suicidal ideation. Anxiety and depressive symptoms have been described as impactful on the newborn’s health at the time of delivery. Despite this, few evidence exist on this topic.

The present paper aimed at assessing: 1) prevalence and risk factors of antenatal depression (AD); 2) the impact of AD on adverse obstetric outcomes and the onset of post-partum depression.

Pregnant outpatients attending the Department of Gynecology and Obstetrics of University of Campania “Luigi Vanvitelli” in Naples were asked to complete the Italian version of Edinburgh Postnatal Depression Scale (EPDS), a 10-item self-reported questionnaire developed as screening tool of postnatal depression up to one year after delivery. Sociodemographic, clinical and gestational information was collected at baseline.

A total of 268 pregnant women were recruited: 9.7% of them already suffered from depressive disorders and 22% from anxiety. EPDS mean total score was ≥10 in 36.2% of cases (97 out of 268). The presence of AD was longitudinally associated to a lower gestational age at the time of delivery and a higher 1 and 5 minutes APGAR scores. Moreover, AD was associated to a higher incidence of labor induction and the need of intensive care for the new-born. Finally, in our sample AD constituted a stable risk factor for EPDS scores within three days, one month and six months after delivery.

The presence of depressive symptoms during pregnancy should deserve a higher clinical attention by health professionals, given the correlations with adverse obstetric outcomes and post-partum mental health. Training programmes should be encouraged and digital psychiatry could represent a strategy to monitor pregnant women at risk.

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